3. Introduction
3.5 The Advocacy Activities, Strategies and Tactics of the Treatment Action Campaign
44
3.4.3 Responses of Jacob Zuma’s Administration to the HIV/AIDS Issue in South Africa On 22 April 2009, Jacob Zuma was elected President of South Africa, and Dr. Aaron Mostoaldi was appointed as Minister of Health (TAC, 2009). By the late autumn of 2009, President Zuma’s cabinet publicised a commitment to test all children exposed to HIV and provide all HIV- positive children with ARVs. Moreover, as per the target set by the National Strategic Plan of 2007-2011, coverage of HIV-positive mothers with AZT treatment was estimated at over 95 per cent by 2010. Transmission from mothers to their children was thereby reduced to just 3.5 per cent (Government of South Africa, 2010). Hence, it soon became clear to the TAC that the dissenting scientific views and denialism that defined Mbeki’s Presidency would not continue to prevail under the new government. To increase discussion of HIV/AIDS, in April 2010, the government of South Africa launched an HIV/AIDS Counselling and Testing (HCT) media campaign. The campaign operated through door-to-door campaigning and billboards to promote the availability of free testing and counselling in health clinics, as well as to reduce the myths and stigma surrounding the disease (South African National AIDS Council, 2011). In 2011, the government amended treatment guidelines so that treatment could be initiated effectively (Plus/
Irin News (2011).
From the literature presented above, it can be argued that what started as a demonstration by a civil society organisation-the Treatment Action Campaign -on universal access to HIV/AIDS treatment, has resulted in shaping the current South African health policy and particularly HIV/AIDS care and treatment.
3.5 The Advocacy Activities, Strategies and Tactics of the Treatment Action Campaign
45
It should be noted that movements based on human rights emerged in the 1980s and early 1990s and by late 1990s, the value of asserting them to demand a normative international standard seemed to have increased in currency in the field of HIV/AIDS in 1998 (Boulle and Avafia (2005). For example, the United Nation’s Joint Program on HIV/AIDS and the UN Office of the High Commissioner for Human Rights (OHCHR) published International Guidelines on HIV/AIDS and Human Rights (Heywood, 2009: 16-17; POLICY Project, 2003: ). It was not until 1999 that an HIV/AIDS activist organisation-the Treatment Action Campaign had adopted the model of ‘treatment literacy’. The model was adopted from the United States of America where AIDS activists, led by people with HIV had pioneered it among the infected. The model explained that in order to fight for their right to health effectively, people should understand the science of HIV and its implication in their bodies, the medicines that might work against it and the relevant research that was needed ( POLICY Project, 2003).
In 1999, the TAC made strategic links with the Gay Men’s Health Crisis (GMHC) and ACT-UP who came to South Africa to provide training to the first cadre of the TAC treatment literacy activists. Treatment literacy is a programme that involves health education and communication aiming to educate HIV-vulnerable and poor people about the science of HIV, health and the benefits of treatment (Boulle and Avafia, 2005). Although treatment literacy is not taught in a neutral or bio-medical format, the information about the science of medicine and health is linked to human rights, political science, equality and the positive duties on the state. To promote treatment literacy in poor communities, the TAC developed basic education materials such as booklets, posters and videos and combined these with an extensive training programme. The TAC’s expectations were that when the poor are armed with relevant knowledge about causes of HIV, the implication it has in their bodies and its effects, they can become their own advocates, thereby empowering them personally and socially (Heywood, 2009: 18). The treatment literacy is therefore a foundation for both self-help and social mobilisation. The Treatment Literacy Practitioners (TLPs) receive both training and a small bursary for one year and then are assigned to clinics and hospitals and community organisations where they conduct further training and agitation for the right treatment (Boulle and Avafia, 2005: 17).
46
In communities where the TAC organised treatment literacy, agitators increased the demand for access to ARV treatment by people with living with HIVAIDS at local clinics, leading to higher rates of make-up and adherence than in comparable communities where a TAC branch was not present (Heywood, 2009: 18). As noted by Boulle and Avafia (2005: 23) that, in an “interview conducted during the evaluation of the TAC, its volunteers are quoted as saying ‘I am living because of TAC’, ‘TAC puts self-esteem back into people ‘, and ‘In TAC you are in a university’. ‘You learn and grow with knowledge’ ”. This access to accurate information coupled with human rights, empowered the marginalised citizens (mostly HIV victims) who began to assume both a public voice and a visibility. This combination of education and mobilisation also consolidated the Treatment Action Campaign’s membership in a growing number of communities in South Africa. Notable also, is that the majority of TAC’s members are HIV positive hence, armed with new tools, a vision and the necessity of gaining access to healthcare services especially for HIV/AIDS treatment brought a new generation of human rights Boulle and Avafia (2005). Aided by the trademark ‘HIV positive’ t-shirt, the TAC formed an organisational coherence while people living with HIV ceased to be silent victims and became advocates for their right to HIV/AIDS treatment (http://www.tac.org.za).
3.5.2 Using Human Rights Instruments-the Constitution and Courtrooms
As the Treatment Action Campaign’s focus has been on the right to health, the determinants of health however, are also access to food, education, clean water and housing. In its Bill of Rights, the South African Constitution recognises these as rights that are just and measurable (Republic of South Africa, 1996). To succeed in popularising the right to health, the Treatment Action Campaign studied and worked closely with progressive lawyers, most of whom they developed skills in using the law to undermine apartheid. The TAC argued that the Constitution created a legal duty on the government to fulfil its human rights provisions. Hence, with regards to the right of access to health care services, the TAC argued that South African government was obliged to take steps to overcome the unaffordability of medicines especially when it has a legal means to do so (Ranchod, 2007: 12; Heywood, 2009: 20). Despite the government’s active defence on these legal measures which it had built into its amended medicine Act, the pressure
47
by the pharmaceutical companies had made it reluctant to use them (Friedman and Mottiar (2004; Heywood, 2009: 21).
Commenting on the subject, Berger (2008) reported that, in making claims for the right to a PMTCT programme and subsequently in the demands for a national ARV treatment plan, the Treatment Action Campaign went beyond demanding that government comply with abstract legal obligations. For instance, the organisation worked with scientists and researchers to develop plans and alternative policy proposals that would meet the requirements of
‘reasonableness’ that jurisprudence of the Constitutional Court (Berger, 2008). The ‘reasonable plan’ is a plan for the delivery of socio-economic rights that has acquired great importance to South African jurisprudence. According to the Constitutional Court, the reasonable plan must be context –specific and dependent on the fact and circumstances of any particular matter and include the following elements:
i. Sufficient flexibility to deal with emergence, short, medium, and long term needs;
ii. Making appropriate financial and human resources available for the implementation of the plan and;
iii. National government assuming responsibility for ensuring the adequacy of law, policies, and programmes; clearly allocating responsibilities and tasks; and retaining oversight of programmes implemented at provincial and local government level (Berger, 2008).
The TAC therefore, framed demands to both pro-poor policy and also policy alternatives based on legal entitlement and as significant duties that rest on government and- where relevant, the multi-national corporations and multi-laterals institutions.
3.5.3 Using Media Technologies
From its inception, TAC’s campaigns attracted media attention. To mobilise support for its advocacy, the organisation developed a relationship with both the main stream media (such as television, radio and newspapers) and new media technologies such as the internet (Nightingale and Dwyer, 2007). Notably also, was that where the campaigns for the treatment literacy programme were being mounted in communities, their outset were missing hence, the TAC had
48
to turn to media (Wasserman in Nightingale, 2007: 38-39) notes that the TAC continued to receive favourable media coverage through radio, and television and daily newspapers. For swift dissemination of information, the Treatment Action Campaign uses new media technologies such as their website (http://www.tac.org.za) which contains information relating to HIV/AIDS, treatment literacy and medication.
To broaden its voice, the TAC continued to attract supporters and membership locally and internationally (Nightingale and Dwyer, 2007). This is done through its mailing lists such as the internet@tac.org.za (Ahmed and Swart, 2003) and Africa@tac.org.za which has been instrumental in the TAC build-up of significant networks with African and global organisations.
The Africa@tac.org.za is one of TAC’s popular mailing lists which is linked to the Pan African HIV/ Treatment Access Movements (PHATAM) and has an average of 1000 members (Nightingale and Dwyer, 2007: 139).The Treatment Action Campaign also communicates through a newsletter (news@tac.org.za) which is sent every fortnight. It is through these mail lists that information is sent out to alert its audience to TAC-related news and events. Therefore, use of these media technologies enables the TAC to spread news and information swiftly and with a reach that is impossible for traditional media.
3.5.4 Using Protests, Marches and Demonstrations
When the formal, legal channel failed, the TAC it took to the streets, challenging authority even flouting the law with the belief that the cause justified it (Ranchod, 2007: 12).
Taking the HIV/AIDS treatment massage to the street was another advocacy strategy employed by the Treatment Action Campaign. According to Friedman and Mottiar (2004), by the year 2002, the Treatment Action Campaign had exhausted all other means and in showing that the decision on HIV/AIDS policy change was not taken lightly, it was forced to enter into a civil disobedience campaign (Kervatin, 1998: 25). While it was crucial that the campaign had to be conducted in a non-violent manner, the TAC activists accepted the consequences of defying legitimate laws and on on 2nd May 2002, more than 5000 supporters of the TAC marched past
49
the Constitutional Court on the day of its hearing of the appeal regarding the government’s failure to provide ARVs in the PMTCT case (Heywood, 2009: 32). The following year, the TAC also took it to the streets as a strategy in response to the government’s failure to sign an agreement at the National Economic Development and Labour Council (NEDLAC) agreeing to an AIDS treatment plan (Friedman and Mottiar, 2004: 13). In the same view (Ranchod, 2007:
12), reported that the TAC achieved this by straddling the division between the CSO and the new social movement, employing strategies from both strains. Thus, when the formal, legal channel failed, it took to the streets, challenging authority even flouting the law with the belief that the cause justified it.
From the perspective of the TAC, engaging in protests was an alternative because its leadership calculated that the campaign could be defended and conducted in a manner which would not interfere with the moral high ground or non-violence on which it stood (Friedman and Mottiar, 2004: 14). It can be argued that the TAC’s advocacy strategy on civil disobedience was a success as it is credited with achieving the Cabinet decision to roll-out ARVs in 2004 as indicated in the timeline of this study. The mobilisation of marches and protests was a positive strategy as it gave the people a voice and was an outlet for grief at deaths that had affected most of its members of the Treatment Action Campaign.
3.5.5 Building Coalitions, Networks and Partnerships
A key feature of international alliances in the era of electronic communication is that they can be sustained without significant resources. Thus, to ensure maximum publicity on its campaign, the TAC strategically developed networks with both international and local organisations. Some organisations such as Gay Men’s Health Crisis and the Treatment Action Group ran workshops for the TAC, making the science of the ‘virususer’-friendly (Friedman and Mottiar, 2004: 22).
Additionally, the TAC’s most consistent international ally has been the Belgian NGO Medicins Sans Frontieres (MSF) which, with the activist group Act Up, put Clinton and Mbeki under pressure about health issues. Another reason for the TAC’s success is the partnership it developed with other civil society institutions such as Congress of South African Trade Unions
50
(COSATU) who was by its side on the issue of Mother-to Child Transmission of HIV. The TAC maintained its alliance with COSATU which it saw as beneficial (Ranchod, 2007: 13). Together with COSATU, the TAC embarked on mass mobilisation and marched demanding for ARVs access (Ranchod, 2007: 14; Boulle, & Avafia, 2005).
Apart from building local alliances, perhaps the TAC’s most strategic and significant alliance with international allies where it support from. Using its international allies, the TAC pressurised the pharmaceutical companies whose head offices abroad feared being portrayed as unsympathetic to the poor who could not afford to buy their medicines. Given the government sensitivity to international opinion, the TAC and other organisations secured international opposition to South African government policy on ARVs roll-out (Friedman and Mottiar, 2004:
3). Accoring to Friedman and Mottiar (2004: 22), the TAC’s most consistent international ally has been the Belgian NGO Medicins Sans Frontieres (MSF) which, with the activist group ‘Act Up’, was putting pressure on Presidents Clinton and Mbeki on health issues. Additionally, organisations such as Gay Men’s Health Crisis and the Treatment Action Group also ran workshops for the TAC. Therefore, the networking made the science of the ‘virususer’-friendly and popular (Friedman and Mottiar, 2004: 22).
From this section, it emerged that the TAC used multiple policy advocacy strategies such as mass mobilisations of marches and demonstrations, networking, partnerships and alliances; and using new media technologies. The advocacy activities of the TAC demonstrates that policy advocacy does not limit itself to only one tool or the eight basic elements-model proposed by Sharma (1997) in chapter two. The advocacy techniques employed by TAC also demonstrates that the TAC seeks to engage with the state without taking it over. The advocacy strategies of the TAC also demonstrate that the organisation employs the methods of civil society engagement which are negotiations, coalition-building, public protest and legal action.
51